Book Summary: Better

Book: Better – A Surgeon’s Notes on Performance

Author: Atul Gawande

Key takeaways: I took away two key things from this book – (i) positive deviance, (ii) diligence, and (iii) history and statistics on medical lawsuits.

Positive Deviance: The key concept here is to find solutions from the insiders rather than exporting solutions from the outside. An interesting story is about how a Save the Children program that was addressing malnutrition in Vietnam succeeded. According to the story, several outside solutions had failed, so the researchers (Sternins) focused to finding solutions from insiders. They asked villagers to identify who among them had the best-nourished children–the ones that showed “positive deviance” and used ideas that these parents were using (some of these ideas were decidedly outside the norm).

How to get to positive deviance –

  1. Ask an unscripted question
  2. Don’t complain : Natural pull of conversational gravity can be litany of woes. But resist it, because it’s boring, doesn’t solve anything and will get you down.
  3. Count something
  4. Write something
  5. Change: look for the opportunity to change

Diligence: People underestimate the value of diligence as a virtue because it appears so mundane and has a flavor of “simplistic relentlessness”, but it’s a pre-requisite of great accomplishments (e.g. polio eradication in India)

Medical Malpractice Lawsuits: 

  • 98% of the American families hurt by medical errors don’t sue (can’t find lawyers who think they’d make good plaintiffs, are too daunted, etc.)
  • 70% of the time, medmal suits are dropped/won by docs in the court.
  • BUT, the cost of defense is high and when docs lose, the avg. jury verdict is $0.5 mm.

How U.S. govt handled suits against vaccines

  • Between 1980 – 86, personal injury lawyers filed $3.5 bn worth of claims against docs and manufacturers of vaccines.
  • As they began to win, vaccine prices jumped and manufacturers began to get out of the business.
  • To address this, Congress stepped in and now all vaccines carry a 75c surcharge that goes to a fund that provides compensation to children injured by the known side-effects of the vaccines (the plaintiffs do have the ability to sue in court if not satisfied).
  • Since 1988, the program has paid out $1.5 bn in damages.

Bill Franklin case in MA that changed the med-mal trajectory 

  • Franklin vs. Mass General was a case that went all the way to the MA Supreme Court in 1980, and led to a change in the law where the statute of limitations should start with the discovery of the harm, not the incident.
  • The lawyer in this case was Michael Mone, who took a case that many thought was very difficult



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